In this his second hard-hitting book on mental health, award-winning science writer Robert Whitaker attempts to answer compelling questions about the inexplicable rise in the number of disabled mentally ill in the US over the past several decades. How could this have occurred, and at a time when the use of highly touted psychiatric medications soared? Why have so many mental illnesses that had previously been short-lived suddenly become chronic? And why are so many children now showing up on the rolls of the mentally disabled?

Whitaker is not an expert in either medicine or psychiatry. His mission was to answer these questions by reviewing the scientific evidence from the numerous studies done by the experts, many of which were kept from the public. One would have expected that ample evidence and hard science underlie the mainstream diagnosis and treatment of mental illness. But this does not prove to be the case. The author's startling findings reveal a widespread lack of science, with the dramatic rise in the use of psych drugs apparently driven strictly by profit motive.

A major issue exposed by Whitaker is that most government drug testing has been limited to the short-term, and on these tests psych drugs often do fairly well, although even here results are frequently mixed. But what's missing is government examination of long-term outcomes of psych drugs before approving them for use. Whitaker's review of this research reveals that long-term results are typically not positive for the drugs. In fact, non-medicated patients usually do better.

These findings have led Whitaker to charge that the drugs may be creating chemical imbalances rather than correcting them. He cites a growing number of experts who contend that psych drugs are highly toxic and addictive and when used long enough can shut down the brain's ability to produce proper amounts of neurotransmitters. This is because when the drug artificially triggers production of a supposedly low neurotransmitter, the brain compensates by producing less. In time the brain may lose the ability to produce normal levels, creating a chronic condition, which can also trigger a host of physical ailments. The experts cited here argue that most psych drugs are reliably safe only when used for short periods.

The book also details numerous occasions when researchers stacked the deck by structuring experiments to favor the drugs, and when unfavorable results were suppressed or spun to sound favorable. Why is this? You have to look at the funding— the great bulk comes from pharmaceutical companies. In fact, Whitaker charges that the billions in drug money dominate the entire psychiatric care industry and its key players, from the American Psychiatric Association to the National Institute of Mental Health, and even the National Alliance on Mental Illness. Most practitioners and "opinion leaders" were trained in the medical model where chemical imbalance is seen as the cause of mental illness, though there has never been adequate scientific evidence. But they believe it. And most are now on the payroll of "Big Pharma." This creates a massive conflict of interest, one that is rarely acknowledged.

Psychiatrists now routinely prescribe psych drugs for an ever-growing number of conditions, many of which were handled without drugs in earlier times, when recovery rates were actually higher. Now acute conditions are leading to chronic illness and disability. Particularly tragic is the dramatic rise in the number of children who are prescribed drugs and see their conditions worsen, only to have dosages increased. They often become permanently disabled according to the evidence compiled by Whitaker. Psychiatrists rarely warn patients of the risks of these drugs, possibly because they themselves don't believe there is real danger.

It can be so easy to accept the conventional wisdom, which seems to be continually confirmed by experience. For example, if a patient suddenly stops taking a psych drug, withdrawal effects will typically cause a deterioration of symptoms. How to feel better? Just resume taking the drug. This common experience seemingly proves the drug's value. And the only patients that psychiatrists see are the ones who continue to have symptoms. The ones who feel better no longer come and stop taking drugs. But they're now out of his view; he doesn't necessarily know they improved and continues to believe that these illnesses require drugs since all his patients seem to need them. It begins with their professional training, and eventually becomes the mindset.

A single book can only do so much and it is perhaps inescapable that some aspects of Whitaker's arguments are on the weak side in my opinion. For one, he could have dealt more thoroughly with the situation where many patients who don't ever take drugs or stop taking them are inherently less severe than those on drugs. This may account for some of the comparatively better results for the non-drug groups. And he gives short shrift to the likelihood that modern, harried lifestyles are at least partly to blame for the sharp rise in mental illness, which many social scientists have been contending. But I don't see this as a major criticism since there are limits to what one book can accomplish.

People take psych drugs because they have been told repeatedly by nearly everyone that the drugs are necessary for their wellbeing. They have trusted this advice, essentially putting their lives in the hands of their caregivers. Now we see that this advice may have been tainted, quite possibly by the simple desire to make a lot of money. The reader is left feeling deceived and betrayed. This situation is nothing less than scandalous and needs to be immediately investigated by an objective third party.

I would strongly recommend this book. Unavoidably, Anatomy of an Epidemic produces many more questions than answers, and we're left wondering who and what to believe. But as a long-term user of antidepressants, I've learned enough about the issues to see the merits of Whitaker's arguments and I have now begun to taper off my medication with the intent to cease use within 3-4 months. (My psychiatrist is overseeing this, now that I've been able to persuade him to try it.) For anyone on a psych drug, I'd recommend that you get a complete review of your situation and demand to see evidence of its long-term risks and benefits.

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